DOS BULLETIN - Dansk Ortopædisk Selskab

2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 89
Reliability of the Mallet Classification and external
rotation in adduction, in patients with Obstetrical
Brachial Plexus Lesions (OBPL)
K. Daubjerg, L.H. Frich, S. Jepsen
Orthopaedic Department, Odense University Hospital
Background: The Mallet Classification provides an assessment of global
shoulder function. There are, however contradictory reports regarding
the significance of interobserver reliability between examiners working
in different clinical settings. Children with OBPL are no exception to
this.
Purpose: The purpose of this study was to determine the interobserver
reliability, of the Mallet Classification System and assessment of external
rotation in adduction, performed by a Physiotherapist and a Paediatric
Orhtopaedic Surgeon.
Methods: This investigation was performed as part of a continuing
prospective study on patients with OBPL presenting to the Department
of Orthopedic Surgery at our institution. 27 children (14 boys), aged 6,3
years (0,7 – 11,6) were evaluated 45 month (26 – 60) after shoulder surgery
by two examiners on two different occasions but for the most on the
same day. For statistical analysis paired t-test was used to compare
means of continuous paired variables (95% confidence intervals). A
Bland- Allmam plot was used to demonstrate disagreements between the
observers. Prior to the initiation of this investigation, consensus building
exercises were performed among the examiners.
Findings: Mean Mallet Score for the Physiotherapist was 12,0 (10,9 –
13,0) and for the Paediatric Orthopaedic Surgeon 12,2 (11,3 – 13,1).
Agreement of the five values involved in the Mallet Score, was also very
good as 71% were evaluated identical, 26% deviated 1 point and only
3% (all values for Trumpet Sign) deviated 2 points. The mean external
rotation in adduction for the Physiotherapist was -3,2° (-13,7 - +7,4)°
and for the Paediatric Orthopaedic Surgeon -0,5° (-8,6 – +7,6)°.
Conclusion: The interobserver reliability was good. Assessment of
global shoulder function using the Mallet Score and external rotation in
adduction can routinely be performed by a Physiotherapist.
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